Selecting a Treatment Regimen Post-Herpetic Neuralgia
interventions) and, in some cases, early referral for nerve blocks to facilitate rehabilitation (eg, complex regional pain syndrome)
Consider nonpharmacologic treatments (eg, physiotherapy, psychological
Initiate pregabalin, topical 5% lidocaine or 8% capsaicin treatment Ineffective, partial response or other diagnosis
Initiate first-line drug monotherapy (gabapentin or pregabalin) Ineffective or not tolerated
Switch to alternate first-line drug monotherapy
(gabapentin or pregabalin) Ineffective or not tolerated
Consider switch to TCA or SNRI Ineffective or not tolerated
Initiate monotherapy with tapentadol or opioid analgesic
Partial treatment response
Consider adding alternative first-line drug
(gabapentin or pregabalin) Partial treatment response Consider switch to TCA or SNRI Partial treatment response
or tapentadol there is a risk of Sero- tonin Syndrome."
"If the opioid selected is tramadol
Consider adding tapentadol or opioid analgesic
Ineffective or not tolerated
Refer patients to pain specialty clinic for consideration of third-line drugs, interventional treatments and pain rehabilitation programs
